the U.S. House of Representatives concluded that EMAC “successfully provided unprecedented levels of response and recovery personnel and assets to the Gulf coast in record time following Hurricane Katrina” (U.S. House of Representatives, 2006). However, the system also suffered from significant disorganization during the crisis. In many cases, physicians were brought in and never used, while in others, physicians were used but not provided with any relief.

One of the significant challenges presented by a disaster of Katrina’s magnitude is managing the flood of volunteers who arrive on scene wanting to provide help. Authorities are often unable to distinguish those who are qualified to provide care from who are unqualified but well intentioned. HRSA was charged by Congress with establishing a national system for identifying, authenticating, and credentialing responders under a program called Emergency Systems for Advance Registration of Volunteer Health Professionals (ESAR-VHP); however, this system had not been sufficiently developed to provide help during Hurricane Katrina.

During Katrina, air ambulance crews also played an important role, assisting in evacuating survivors from flooded areas. Overall, 27 civilian EMS helicopters were involved in evacuating Tulane Medical Center, Charity Hospital, and other facilities (Lindstrom and Losavio, 2005). In many cases, the helicopters used the roof of the hospital parking garage as a landing zone, and patients were brought upstairs to meet them. Despite these efforts, however, which took place largely without the aid of FEMA (U.S. House of Representatives, 2006), evacuations from these facilities were highly disorganized and agonizingly slow.

Patients who survived the evacuation were treated initially and then transported via buses and airplanes to hospitals in other cities for definitive care. However, this process also suffered from significant disorganization and delays. Many patients were evacuated to the airport but were left there for hours or days before being transported. Others were sent to distant cities with little or no information about where they were going or how they could find out about the location of their families. The NDMS did a poor job of allocating the patient load. Some cities, such as Houston and Atlanta, were inundated with patients, while others, such as Winston Salem, North Carolina, and Augusta, Georgia, received very few.

In Houston and Dallas, the Metropolitan Medical Response System (MMRS) was activated to coordinate the provision of shelter and medical care to evacuees. The MMRS was founded in 1996 by DHHS in response to the increased terrorist threat demonstrated by the Tokyo subway sarin attack in March 1995 and the Oklahoma City bombing in April 1995. The program was designed to enhance and coordinate local and regional response capabilities for highly populated areas that could be targeted by a terrorist attack using weapons of mass destruction. The MMRS concept



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